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� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township • Year
�� State Fortn 03709 (RS l 4-03) _ �
PmscnG4 6y Department ol Local Cwvernment Finance
�NSrRUCr�oNS: ��� �e9n�05
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real PropeRy: During the 12 months be%re May 11 0! the year the deduction is to be eRect�' �
2J Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0/ the year the�BebS�o��e eflective.
See reverse side for addifional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant (owner r confract buyer - see restnctions on reverse side)
Taxing Distrid Key number / legal descrip[ion Record number pt �
CJ
Q� o DO /OG '/�r Page number ���
( CJL!
Assessed value of real property as of MoRgage / Contrad indebledness unpaid as of Is the applicant the sole tegal or.equitable
March 1, current year March 1, current year �p I Q 5� / owner? ❑ Yes ❑ No
U V �i� O U
If no, what is his /-her exact share of interest? If owned with someone other han spouse, indicate with whom.
c,�� - ao -c� _ ���'D. /a% �o3
If name on record is different than that of appiicant, indicate betow: Is the property in question:
❑ Real Property ❑ Mobile Home pC G1.1-�
��me of mortgagee.or conlraci seiler \ . �
{1% �
Address oi mortgagee or contrad seller (number a st�eet, city, state, ZI
C5�- 31g
Name of assignee or olher owner or holder oi mortgage
Address oi assignee (num6er and st2et, city, state, ZIP code)
Does applipnt own property in any olher If yes, what counry? What Taxing Dislrict? Has this dedudion been requested on
county in Indiana? property for current year? [j Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 20 �� 20 20 20 20
�� P P ��
Signature County Auditor Date
I We rtify under the penalty of perjury thal the above and foregoing information is true and corred and that the applicants was / were
a resi nt of Indiana and owner of the aforementioned property on March 1, 20
ig tur///e���(owners full name) Person authorized by duly executed Power of Aitomey
—�� ' or by IC 6-1.1-12-.07
Ful resident a ress f pplicant Addr of authorized person
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